To refer by telephone, you may call directly to 352-742-6809 or 866-742-6655 or email questions about referrals to admissions@cornerstonehospice.org.

Initially we need the following basic information:

1.  Referral Source (Physician, Facility, Hospital, other Hospice, other)  

  • Name / Agency
  • Phone Number
  • Name of Person Calling in Referral

2.  Patient Info 

  • Patient’s Name
  • Patient’s Date of Birth
  • Social Security Number
  • Gender
  • Patient’s Address (Home, Assisted Living Facility, Nursing Home, Hospital)
  • Patient’s Phone Number

3.  Primary Caregiver 

  • Name/Relationship
  • Primary Caregiver’s Phone Number

4.  Payor Source / Insurance

5.  Referring Physician 

  • Physician’s Name
  • Physician’s Phone Number
  • Physician’s Fax Number

6.  Patient’s Hospice Diagnosis (Primary)

7.  Patient’s Other Diagnosis(es)

8.  Plans for Treatment; i.e., Chemo or Radiation

9.  Patient’s Condition or Special Instructions

10.  Indicate for full Hospice or Transitions program

Once the information is received, we will be in touch to have the Referring Physician Agreement signed.